Preoperative preparation of patients with coronary artery disease and comorbidity of chronic obstructive lung disease to scheduled coronary artery bypass graft surgery

We aimed to assess an impact of different prehabilitation schemes on a risk of postoperative cardiorespiratory complications after coronary artery bypass graft surgery (CABG) in patients with coronary artery disease (CAD) and comorbid chronic obstructive pulmonary disease (COPD). Methods. Two groups of patients with CAD and comorbid COPD who were planned for CABG were recruited in the study using the pairwise testing. A criterion of difference was the treatment with tiotropium/olodaterol (Tio/Olo) as one of prehabilitation components. An occurrence of postoperative cardiorespiratory complications was analyzed according to prehabilitation schemes used. Results. The patients with CAD + COPD treated with Tio/Olo during 12.4 ± 5.4 days prior to CABG surgery demonstrated improvement in clinical and laboratory parameters characterizing the severity of COPD just before surgical coronary revascularization. A risk of postoperative cardiovascular and respiratory complications was higher in patients not receiving bronchodilator therapy before the surgery.

1. Arutyunyan L.A., Nelayev V.S., Mashkin A.M. et al. Biomarkers of risk of fatal and non-fatal complications after surgical coronary revascularisation. Meditsinskaya nauka i obrazovaniye Urala. 2015; 16 (2-1 (82)): 65–69 (in Russian).

2. Rahmanian P.B., Kröner A., Langebartels G. et al. Impact of major non-cardiac complications on outcome following cardiac surgery procedures: logistic regression analysis in a very recent patient cohort. Interact. Cardiovasc. Thorac. Surg. 2013; 17 (2): 319–326. DOI: 10.1093/icvts/ivt149.

3. Wrobel K., Stevens S.R., Jones R.H. et al. Influence of baseline characteristics, operative conduct and postoperative course on 30-day outcomes of coronary artery bypass grafting among patients with left ventricular dysfunction: results from the surgical treatment for ischemic heart failure (STICH) trial. Circulation. 2015; 132 (8): 720–730. DOI: 10.1161/CIRCULATIONAHA.114.014932.

4. Cingoz F., Oz B.S., Arslan G. et al. Is chronic obstructive pulmonary disease a risk factor for epistaxis after coronary artery bypass graft surgery? Cardiovasc. J. Afr. 2014; 25 (6): 279–281. DOI: 10.5830/CVJA-2014-061.

5. Bazdyrev E.D. Respiraotry abnormalities in patients with ischaemic heart disease after the planned coronary artery bypass surgery. Kompleksnyye problemy serdechno-sosudistykh zabolevaniy. 2017; 6 (2): 65–78 (in Russian).

6. Bazdyrev E.D., Polikutina O.M., Kalichenko N.A., et al. Postoperative cardiorespiratory complications in patients with coronary artery disease after the planned coronary artery bypass surgery: a relationship with lung function. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2017; 21 (2): 85–97 (in Russian).

7. Bokeriya L.A., Aronov D.M. et al. Coronary artery bypass surgery in patients with coronary artery disease: rehabilitation and secondary prevention. Russian Clinical Guideline. KardioSomatika. 2016; 7 (3-4): 5–71. Available at: http://www.scardio.ru/content/Guidelines/rekom-koron-shunt-2016.pdf [Accessed 22 April, 2018] (in Russian).

8. Bokeriya L.A., Golukhova E.Z., Medresova A.T., and Kazanovskaya S.N. Noninvasive ventilation for prevention of clinically significant pulmonary complications at early post-surgery period after cardiovascular surgery. Kreativnaya kardiologiya. 2014; (1): 37–47. Available at: https://cardiology-journal.com/catalog/web/viewer.php [Accessed 22 April, 2018] (in Russian).

9. Pomeshkina S.A., Borovik I.V., Krikunova Z.P., et al. Efficacy of early physical rehabilitation of patients underwent coronary artery bypass surgery. Sibirskiy meditsinskiy zhurnal (Irkutsk). 2012; 110 (3): 37–40 (in Russian).

10. Wibmer T., Rüdiger S., Heitner C. et al. Effects of nasal positive expiratory pressure on dynamic hyperinflation and 6-minute walk test in patients with COPD. Respir. Care. 2014; 59 (5): 699–708. DOI: 10.4187/respcare.02668.

11. Guner S.I., Korkmaz F.D. Investigation of the effects of chest physiotherapy in different positions on the heart and the respiratory system after coronary artery bypass surgery. Toxicol. Ind. Health. 2015; 31 (7): 630–637. DOI: 10.1177/0748233713480210.

12. Shmelev E.I., Kuklina G.M. Correction of broncho-obstructive syndrome in patients with pulmonary tuberculosis. Meditsinskiy Sovet. 2013; (3): 20–24. DOI: 10.21518/2079-701X-2013-3-20-24.

13. Chronic Obstructive Pulmonary Disease. Federal Clinical Guideline. Available at: http://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii/ [Accessed 22 April, 2018] (in Russian).

14. Bateman E.D., Ferguson G.T., Barnes N. et al. Dual bronchodilation with QVA149 versus single bronchodilator therapy: the SHINE study. Eur. Respir. J. 2013; 42 (6): 1484–1494. DOI: 10.1183/09031936.00200212.

15. Belevskiy A.S., ed. Global Strategy on Diagnosis, Treatment and Prevention of Chronic Obstructive Pulmonary Disease (Update 2011). Translated from English. Moscow: RRO; 2012 (in Russian).

16. Dhillon S. Tiotropium/Olodaterol: a review in COPD. Drugs. 2016; 76 (1): 135–146. DOI: 10.1007/s40265-015-0527-2.

17. ZuWallack R., Allen L., Hernandez G. et al. Efficacy and safety of combining olodaterol Respimat® and tiotropium HandiHaler® in patients with COPD: results of two randomized, double-blind, active-controlled studies. Int. J. Chron. Obstruct. Pulmon. Dis. 2014; 9 (1): 1133–1144. DOI: 10.2147/COPD.S72482.

18. Ferguson G.T., Fležar M., Korn S. et al. Efficacy of Tiotropium + Olodaterol in patients with chronic obstructive pulmonary disease by initial disease severity and treatment intensity: a post hoc analysis. Adv. Ther. 2015; 32 (6): 523–536. DOI: 10.1007/s12325-015-0218-0.

19. Koch A., Pizzichini E., Hamilton A. et al. Lung function efficacy and symptomatic benefit of olodaterol once daily delivered via Respimat® versus placebo and formoterol twice daily in patients with GOLD 2–4 COPD: results from two replicate 48-week studies. Int. J. Chron. Obstruct. Pulmon. Dis. 2014; 9 (1): 697–714. DOI: 10.2147/COPD.S62502.

20. Buhl R., Maltais F., Abrahams R. et al. Tiotropium and olodaterol fixed-dose combination versus mono-components in COPD (GOLD 2–4). Eur. Respir. J. 2015; 45 (4): 969–979. DOI: 10.1183/09031936.00136014.

21. Singh D., Ferguson G.T., Bolitschek J. et al. Tiotropium + olodaterol shows clinically meaningful improvements in quality of life. Respir. Med. 2015; 109 (10): 1312–1319. DOI: 10.1016/j.rmed.2015.08.002.

22. Beeh K.M., Westerman J., Kirsten A.M. et al. The 24-h lung-function profile of once-daily tiotropium and olodaterol fixed-dose combination in chronic obstructive pulmonary disease. Pulm. Pharmacol. Ther. 2015; 32: 53–59. DOI: 10.1016/j.pupt.2015.04.002.

23. Cazzola M., MacNee W., Martinez F.J. et al. Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur. Respir. J. 2008; 31 (2): 416–469. DOI: 10.1183/09031936.00099306. Received October 13, 2017